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Thursday, November 5th, 2009

[digg-reddit-me]Rush Limbaugh, Dick Cheney, Glenn Beck, Sarah Palin, CharlesKrauthammer, and other right wingers have begun to converge on a unified theory of Obama – a systematic critique of who he is, what he stands for, and what he is trying to do. Part of this theory – one of the core themes being developed – is that Obama is the most far left American leader ever. Rush Limbaugh expresses this as well as anyone – and I’ve spliced together two clips from his interview this past Sunday with Fox News. (Full interview here.)

Let’s take two of these quotes out for a moment:

We’ve never seen such radical leadership at such a high level of power…

I don’t know of any Republican who would try to take over one sixth of the U.S. economy. I don’t know one Republican who would put forth this…this…irresponsible cap and trade bill. I don’t know one Republican who would actually do that.

To understand why this is such a bizarre thing to say you need to look at some history. It illustrates what I mean when I call the Republican Party and the right wing – and much of our public debate as it attempts to find the middle ground between the right and left – unhinged. Take a minute to look at the history of the policy proposals regarding the two examples Limbaugh cites – health care and cap and trade.

Health Care

The plans moving through Congress now have an historical precedent in most of their aspects in the two serious Republican attempts to reform health care after LBJ’s introduction of Medicare and Medicaid – Richard Nixon’s health care proposal in 1974 and the Dole-Chafee bill in 1993. Between the two bills, they contained a technocratic institution to reign in health care spending by looking at medical practices – similar to the IMAC that Sarah Palin called a death panel (Richard Nixon’s proposal); an individual mandate, an extension of Medicaid eligibility (the Dole-Chafee plan); an end to insurance industry abuses – for example, banning people with preexisting conditions, subsidies or vouchers for individuals who couldn’t afford health insurance to purchase it, and the creation of a standard minimum level of benefits for health insurance plans (both plans.)

Those who developed the base model that of health care reform now – used these models as the base onto which they grafted a health insurance exchange and a public option. They combined market forces with decentralized decision-making – the exchange on which private companies would offer health insurance – with a more top-down centralized approach – the public option which would compete with the private companies. Clearly, though the plan is distinctly liberal, it was developed by people who have a deep appreciation for some of the central conservative critiques of government planning and New Deal/Great Society-style liberalism. The plan is also clever politically – as a great majority of the American people, in their wisdom, see great value in having a choice between public option and a private one. Michael F. Cannon of the libertarian Cato Institute accidentally justified the rationale behind this popular sentiment:

Any payment system creates perverse incentives…which is why we need competition between different payment systems to temper the excesses of each.

Unlike the Dole-Chafee bill which sought to undermine the current system with the hope that something else would develop, the plans working through Congress now are more conservative as they seek to preserve the status quo while introducing an alternative model that people could opt into if it works.

You wonder how far to the right the Republican Party Rush imagines is if he claims he doesn’t know any Republican who would propose anything like this.

The one thing that makes this plan distinctly liberal is the public option. Yet, if anyone believes that after dropping it, the Republicans would support a health care bill, they haven’t been paying attention.

Cap and trade started out as a hair-brained scheme to solve the problem of acid rain thought up by a Reagan administration lawyer, C. Boyden Gray. Environmentalists and liberals hated the idea. They saw it as a license to pollute, a “morally bankrupt” “license to kill,” or more reasonably as a “scheme for polluters to buy their way our of fixing the problem.” They preferred the more “command-and-control” approach of top-down regulation. Regulators resisted the idea – as it forced them to surrender “regulatory power to the marketplace.” Industry opposed it, claiming it “was going to shut the economy down.”

But George H. W. Bush thought that free market principles could realign the incentives to fix this problem – and he wanted to placate the Canadians who were bearing the brunt of the acid rain.

So he pushed through a cap and trade scheme to eliminate acid rain over these strong objections. It beat all expectations. Eventually environmentalists came around and industry continued to thrive. This Republican success on solving a major environmental issue without top-down regulation made cap and trade a popular, bipartisan idea. Eventually, Bill Clinton saw it as a way to tackle global warming. But as a significant minority of Republicans continued to question whether or not global warming was real and whether or not it was man-made (along with every other scientifically moot question that industries raised) any possible deal was postponed. Still, as late as 2008, the Senate had strong bipartisan support for a cap and trade program – with Joe Lieberman and John McCain taking the lead. Now McCain is a major opponent of the cap and trade legislation, complaining about the lack of support for nuclear reactors in the bill as a reason to oppose it. This when as late as a year ago, he reiterated his statements of the past eight years in saying that global warming demanded “urgent attention” – that we must “act quickly” to “dramatically reduce our carbon emissions” with a “cap-and-trade” program.

As I said regarding health care, if anyone thinks that McCain will come around to support this legislation that is so similar to what he supported as essential a year ago if the Democrats just tossed some more money into nuclear energy, then you haven’t been paying attention. McCain will likely start calling it a “power grab” and a “government takeover” of the world, echoing Cheney and Krauthammer by the time the bill is up for a vote.

Conclusion

In both cases, Republicans proposed ideas based on core conservative principles – on a respect for the free market, on avoiding rapid change, on avoiding top-down regulation. And now Democrats led by Barack Obama have taken up these proposals – amending them somewhat to take into account liberal ideas such as a distrust of large corporations and a concern for community goods – hoping to pass bipartisan legislation.

What they are met with instead is screams of “Socialism!” and “Government takeover!” and “Unprecedented!” “Attacks on liberty!” and “Why do you hate America?”

This piece points out that Obama has adopted much of the Republican framework for dealing with health care – picking up on the work of liberals such as Jacob Hacker and Peter Orszag. This framework was broadly endorsed by John Edwards, and then Hillary Clinton, and then Barack Obama during the campaign. The plan Obama is pushing attempts to combine the best elements of the conservative Republican plans with the goals and certain important elements of liberal alternatives. As a liberal, I acknowledge that this plan is modest – tinkering even – but this is its strength rather than weakness.

The bill is framed in terms of Republican attacks on the Democratic bill, not in terms of its own aims or methods. Which is fine, and to be expected. If I were a Republican, I wouldn’t spend my time crafting a health-care reform plan, either. Republicans don’t have the votes to pass a bill, and they know it.

On health care, the reason he’s had such resistance is because he promised reform, not a radical remaking of the whole system.

Though this is a common claim by right wingers attacking Obama, it clearly isn’t true. Obama’s health reforms take great pains to preserve the current system – and is indeed based largely on two conservative attempts to reform health care in the past. The hope of liberals is that this reform could establish a structure: health insurance market with a public option, that could gradually be opened up to the rest of the population if it was successful. But that isn’t what we’re talking about now.

Given that his criticism of Obama’s health care position is that it is “a radical remaking of the whole system,” you would think Krauthammer would offer a few conservative measures. But if that is what you think, then you have misunderstood the right wing. Krauthammer proposes to entirely tear down the current system: “It is absolutely crazy that in America employees receive health insurance from their employers,” he says, and proposes we gut this system by eliminating the tax break for health insurance and eliminate the prohibition on interstate insurance (which would effectively strip any regulation from insurance companies as the state with the least regulation could attract these companies in a race to the bottom…) By any standard, and whether you agree with them or not, these are radical measures that would completely remake our system of health insurance – and they were also the two cornerstones of the proposal by the McCain campaign.

What Krauthammer either doesn’t know or attempts to elide is that Obama’s health care plan has two prominent historical predecessors: Richard Nixon’s proposal in 1974 and the Dole-Chafee bill sponsored by the Republicans as an alternative to Bill Clinton’s approach in 1993. If you want to figure out what Republican health care reform might be, this is where to look. One of the key things to realize when looking at these plans is that we currently have a hybrid system: with the elderly, veterans, and the poor receiving government-provided health insurance; many of the employed receiving employer-provided health insurance; and those left out either without health insurance or using the much more expensive and less stable individual health insurance market.

1974: Nixon’s Plan

At the crest of the liberal era, Richard Nixon attempted to reform health care. He called his plan CHIP, or Comprehensive Health Insurance Plan, and its goal was to solidify the hybrid system that existed. He proposed expanding eligibility for Medicaid, expanding Medicare to cover prescription drugs, subsidizing the poor to get insurance, incentivizing employers to provide health insurance, and eliminating discrimination on the basis of preexisting conditions.

A form of the Indepedent Medicare Advisory Council called the Professional Standards Review Organization, both being independent technocratic bodies composed primarily of doctors which would be charged with ensuring quality care while “helping to bring about significant savings in heath costs,” to use Nixon’s phrase. (Under Obama, this group would be significantly checked by Congress, and Obama has specified one way that excess treatments could be minimized – by compiling medical knowledge about best practices into a non-binding database.)

A commitment that health insurance would “cost no American more than he can afford to pay,” in Nixon’s words, which specifically meant subsidizing health insurance for the poor who could not afford it and were not provided it through their employers.

A commitment to build “on the strength and diversity of our existing public and private systems of health financing” and to harmonize “them into an overall system,” as Nixon said.

The banning of discrimination on the basis of preexisting conditions.

The standardization of a basic level of health insurance including setting maximim out of pocket costs per year and setting a minimum level of what would be covered.

A federally issued “Health-card” which would be “similar to a credit car” and “be honored by hospitals, nursing homes, emergency rooms, doctors and clinics across the county” and would include “identity information on blood type and sensitivity to particular drugs.” (Obama’s plan contains no such thing, probably to avoid concerns of federal overreach and the hysteria which accompanies talk of a national identification card.)

One of the great regrets of Ted Kennedy’s life was that he did not take the deal Nixon offered him on health care. It’s also noteworthy that Nixon at this point was insistent on strengthening the employer-provided health insurance system and the government-provided health insurance system. He also pushed the idea of HMOs which Bill Clinton’s plan was later demonized for encouraging as well.

1993: The Dole-Chafee Bill

In 1993, some Republicans believed they needed to come up with an alternative to Bill Clinton’s health care plan (in contrast to the, “Just Say No” approach advocated by Will Kristol at the time, and again today) – with 20 Republican Senators eventually introducing to great fanfare the Dole-Chafee bill. This bill was flawed and politically impossible to get through Congress given the many interests it offended – from labor to the elderly to big corporations. This was because it’s main goal was to undermine the employer-provided health insurance system and to a lesser degree the government-provided health insurance system. The Republicans saw these as distancing individuals from the cost of their health care decisions and thus as two of the main drivers of increasing costs – though they did not acknowledge or attempt to fix any of the problems which made the individual health insurance market untenable for most. This bill included:

An individual mandate enforced by a penalty imposed on those who did not comply.

A government voucher to purchase health insurance for individuals to up to 240% of the poverty line. (Which is more generous than the Senate Finance bill which only offered subsidies for families up to 200% of the poverty line.)

A cap on how much health insurance could be deducted as a tax credit (similar to what the Senate Finance Committee proposed recently, which Republicans denounced as raising taxes.)

The removal of the tax credit for all private health insurance plans that did not provide a “federally guaranteed package of health care benefits.” (Which is more radical than anything Obama is proposing – and a greater reach of the government into the private sector.)

The elimination of discrimination on the basis of preexisting conditions.

Financing through cuts in Medicare Part B and the limits in tax credits discussed above.

“Obamacare”

Compare the above to the plans now circulating in Congress and backed by Obama.

They have many of the same goals:

reducing the growth of health care spending;

eliminating the holes in our insurance system and insuring the uninsured;

eliminating abuses by the health insurance industry.

They have some similar mechanisms to achieve these goals:

regulation of health insurance industry;

individual mandate;

subsidies for those who cannot afford insurance;

technocratic panels.

The health care reforms being proposed today are based on the same framework as the two Republican plans of the past with one main exception: they provide a mechanism to allow the individual market to work more effectively. The health care reforms today attempt to preserve the current system – which is deteriorating year by year as more and more people are priced out of health insurance – while alleviating the worst problems and providing a separate and regulated market in which individuals could choose between different health insurance models.

While both the Nixon and Dole-Chafee bills sought to change the health insurance industry through pure government regulation and intervention. The Democratic proposal working its way through Congress now adds two elements – one from the left and one from the right. They propose creating a Health Insurance Exchange – a market for health insurance. On this exchange, one could choose a publicly-run insurance plan.

The model the Democrats are working on now clearly owes a great deal to these two Republican attempts at health care reform. It’s a shame that Republicans have now taken to demonizing Obama’s plan on many of the very grounds that would necessarily be at the core of an actual conservative attempt to tackle health care.